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Niger: Hepatitis E Outbreak in Diffa Takes a Toll on Those Most Vulnerable

An MSF doctor tends to a patient during a followup consultation at the maternal and pediatric health center in Diffa, Niger.

June 21, 2017

Two months after the declaration of a hepatitis E outbreak in Niger’s Diffa region, the humanitarian response is still lacking due to insufficient resources and coordination between actors. The outbreak is taking a heavy toll on some of the area’s most vulnerable people, especially pregnant women and refugees and internally displaced people who fled conflict between Boko Haram and armies in the region. So far this year, from January 2 to June 11, of the 186 women admitted to the main maternal and pediatric health center in the town of Diffa, 34 died of severe complications related to hepatitis E. The majority of the 876 cases of hepatitis E reported as of June 11 were among refugees and displaced people.

Instability and Lack of Infrastructure

In Diffa, poor access to medical care hampered by insecurity along with the lack of adequate water, sanitation, and hygiene infrastructure have severely exacerbated the health crisis. Several sites within the area's communities and camps for displaced people do not have adequate supplies of drinking water. In addition, there is a lack of latrines, and those that do exist are in poor condition.

If the situation continues to unfold as have other hepatitis E outbreaks in Africa, the current crisis in Diffa could last for several more months. The number of suspected cases may increase further with the imminent arrival of the rainy season, which usually comes from June to September. "Given the scarcity of water for the most vulnerable populations, the risk is that alternative sources that can spread the outbreak will be used, such as the supply from streams and other natural water points formed by accumulated rain water," says Audace Ntezukobagira, MSF emergency coordinator in Diffa. "These collection points are considered potential vectors of the disease. It is also important to take into account that these people do not have the material or financial means to stock up on wood or gas, to boil the water in order to make it suitable for consumption."

Water, Hygiene, and Sanitation Services

To fight the outbreak, water and sanitation activities in the region must be strengthened. However, the current response has not yet reached the standard required due to insufficient resources and coordination between humanitarian actors.

At certain sites, for example, jerry cans that become unsuitable for transporting water are frequently not systematically collected when they are replaced. "This provokes a clear problem in terms of the risk of spreading the disease, as well as creating confusion, as new jerry cans could be distributed several times in the same place," says Sabiou Mansour, logistics manager for the MSF emergency team in Diffa. "It is deplorable, considering the efforts already provided in the region and the magnitude of the needs."

In response, MSF has strengthened its capacity to deploy emergency sanitation and hygiene measures at eleven sites since April 2017. MSF teams working on more than 130 functional water points ensured that more than 6,300 cubic meters of water were chlorinated; 127,300 jerry cans were washed and nearly 3,400 old ones were replaced; and cleaning kits, including more than 36,800 soaps, were distributed.

Patient Treatment

The response to the outbreak also includes free care for patients in health facilities at the community level and referral to hospitals for those who develop complications. To these ends, MSF teams support the health authorities with human and material resources that have been deployed to deal with the situation.

Patients suffering from hepatitis E also receive psychological support, and MSF provides technical support for health staff in the structures in which it operates to ensure free, high-quality care. Once services began, a decrease in mortality was observed among women admitted to the main maternal and pediatric health center in the town of Diffa with severe complications related to hepatitis E.

Awareness-Raising in the Heart of the Community

MSF also carries out health promotion activities in health facilities and in the community. To date, nearly 32,000 people have received education on hepatitis safety, including patients and their families. At the same time, MSF is actively looking for cases in villages, which has already led to the referral of more than 400 people to health centers.

MSF in Diffa

MSF has been working in the Diffa region since the end of 2014, providing care to people fleeing violence related to the conflict between Boko Haram and armies in the region. MSF provides free medical and psychological assistance in seven health centers in the region, and supports the supply of drinking water, the construction of latrines, and the distribution of essential items in several villages and places where refugees, returnees, and displaced people have gathered.

MSF also supports the Nigerien Ministry of Health in Nguigmi Hospital and at the main maternal and child health center in Diffa town. In both hospitals, MSF works in reproductive and pediatric health units and provides mental health support. At the hospital in Nguigmi, the team also treats children suffering from severe acute malnutrition.